Surfactant replacement in spontaneously breathing babies with hyaline membrane disease--a pilot study.

In a neonatal unit which, at that time, had no facilities for artificial ventilation, 14 newborn infants with birth weight greater than or equal to 1,500 g fulfilling the diagnostic criteria for severe hyaline membrane disease (HMD) were treated by tracheal instillation of bovine surfactant (200 mg/kg). Twelve of these babies showed increased transcutaneous PO2/FiO2 ratio within 2 min, the average therapeutic response being sustained for at least 72 h. One of the two babies who did not respond to treatment was later diagnosed as a case of group B streptococcal pneumonia. One baby with favorable initial response died from sepsis at the age of 7 days; the other patients survived without sequelae. We conclude that treatment with exogenous surfactant might be considered as an alternative to ventilator treatment in babies with severe HMD.

Specific and non-specific serological markers in the screening for congenital CMV infection.

IgM antibodies specific for cytomegalovirus (CMV) were demonstrated in 15 (2.6%) of 575 umbilical cord sera obtained from newborns in Kuwait. Some 93% and 50% of these CMV-IgM positive cord sera displayed markedly raised (more than normal mean +2 S.D.) content of total IgM and IgA respectively. In contrast, only 0.2 and 1.8% of the CMV-IgM negative cord sera had elevated total IgM and IgA, respectively. Rheumatoid factor (RF) was demonstrable, at concentrations of 30 IU/ml or more, in 67% of the CMV-IgM positive as compared with 3.2% of the CMV-IgM negative sera whereas interferon alpha was found in the serum of only one of these infants. These results indicate that raised total immunoglobulin, in particular IgM, concentrations and the detection of RF in cord blood are useful non-specific markers for the identification of congenital CMV infection.

Prospective serological and clinical studies on infants born in Kuwait with an elevated IgM in cord blood.

Little is known about congenital viral and toxoplasmal infections in the developing countries. This study attempts to provide preliminary data on such infections among Arab mothers and infants in Kuwait. Babies born with an elevated IgM in cord blood were selected at birth and then studied prospectively during the first year of life for serological and clinical evidence of viral and toxoplasmal infections. There appeared to be a significant association between the elevation of total cord blood IgM and the selection of cases with cytomegalovirus infection. Demonstration of specific IgM in cord sera was attempted, whenever possible, to provide further evidence of congenital infection and to exclude early postnatal infections. In 18.5% of cases there was an association between serological evidence of infection and certain clinical abnormalities. Apart from cytomegalovirus and rubella virus, no evidence was found for congenital infection by other viruses or toxoplasma in this study.

Seroepidemiology of viral and toxoplasmal infections during pregnancy among Arab women of child-bearing age in Kuwait.

Five hundred and seventy three of 606 (94.6%), 583 of 604 (96.5%) and 575 of 595 (96.6%) women were found to have antibody to rubella virus, cytomegalovirus and herpes simplex virus, respectively. The Geometric Mean Titre (GMT) of haemagglutination-inhibition antibody to rubella virus was 60.97, while the GMT of complement-fixation antibody to cytomegalovirus and herpes simplex virus were 28.49 and 25.01, respectively. Furthermore, 301 of 517 (58.2%) women were also found to possess antibody to toxoplasma (GMT = 10.12) as detected by the passive-haemagglutination test. No significant differences in antibody prevalence or GMT could be found among the various nationalities studied except among Bedouins who showed a significantly higher rate and GMT of antibody to rubella virus and for the Mediterranean Arabs who showed significantly higher rate of immunity to and GMT of toxoplasma antibody when compared to other nationalities. Finally, no significant differences in antibody prevalence or GMT could be found among the various age groups.